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Published on: November 20, 2015
Plagiocephaly and Developmental Delay: A Systematic Review
Alexandra L C Martiniuk1, Cassandra Vujovich-Dunn, Miles Park
1*School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; †Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ‡Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; §Built Environment, Industrial Design Research Collaboration, University of New South Wales, Sydney, New South Wales, Australia; ‖Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia; ¶Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia; **Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Infants with deformational plagiocephaly (altered head shape) have an increased risk of developmental delays, particularly motor delays. Early intervention is recommended for affected infants.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Clinical epidemiology
Background:
- Deformational plagiocephaly, encompassing plagiocephaly and brachycephaly, is a prevalent pediatric condition.
- Infants with abnormal head shapes are frequently observed to have developmental delays.
- The prevalence and persistence of developmental delay in infants with plagiocephaly remain unclear.
Purpose of the Study:
- To systematically review the existing literature on the association between plagiocephaly and developmental delay.
- To provide evidence-based guidance for clinical practice regarding infants with plagiocephaly.
Main Methods:
- A systematic review of MEDLINE, EMBASE, CINAHL, and PEDro databases was performed.
- Data extraction included study sample, follow-up, design, and findings.
- Methodological quality was assessed using a critical appraisal tool.
Main Results:
- 19 studies met inclusion criteria from 1315 initially identified articles.
- A positive association between plagiocephaly and developmental delay was found in 13 of 19 studies, notably in 4 of 5 high-quality studies.
- Motor delay was the most common domain affected, especially in younger children (≤24 months) and in high-quality studies.
Conclusions:
- Plagiocephaly serves as an indicator of heightened risk for developmental delays in infants.
- Close monitoring for developmental delays is crucial for infants diagnosed with plagiocephaly.
- Early referral to services like physiotherapy can mitigate motor delays and identify long-term developmental needs.
Objective:
Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common pediatric condition. Infants who present with altered head shape often experience developmental delay. It is uncertain how common developmental delay is in infants with plagiocephaly and how sustained this is, when present. This review explores the association between plagiocephaly and developmental delay to guide clinical practice.
Study Design:
A systematic review was conducted. MEDLINE, EMBASE, CINAHL, and PEDro databases were searched. Data from relevant studies were extracted regarding study: sample, follow-up, design, and findings. Methodological quality of each study was rated using a critical appraisal tool.
Results:
The search recovered 1315 articles of which 19 met the inclusion criteria. In the included studies, the children's ages ranged from 3 months to 10 years. Study limitations included selection bias, nonblinding of assessors, and reuse of the same study population for multiple papers. Most papers (11/19) rated "moderate" on methodological quality. A positive association between plagiocephaly and developmental delay was reported in 13 of 19 studies, including 4 of 5 studies with "strong" methodological quality. Delay was more frequently in studies with children ≤24 months of age (9/12 studies) compared with >24 months of age (3/7 studies). Motor delay was the most commonly affected domain reported in high-quality papers (5/5 studies).
Conclusion:
This review suggests plagiocephaly is a marker of elevated risk of developmental delays. Clinicians should closely monitor infants with plagiocephaly for this. Prompt referral to early intervention services such as physiotherapy may ameliorate motor delays and identify infants with longer term developmental needs.
